title: Long-term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy.
abstract: OBJECTIVE
  We evaluated the structural-functional relationships and the prognostic factors for renal events, cardiovascular events, and all-cause mortality in type 2 diabetic patients with biopsy-proven diabetic nephropathy.
  
  
  METHODS
  Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy (n = 260) were enrolled. Patients were stratified by albuminuria (proteinuria) and estimated glomerular filtration rate (eGFR) at the time of renal biopsy. The outcomes were the first occurrence of renal events (requirement of dialysis or a 50% decline in eGFR from baseline), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, coronary interventions, or nonfatal stroke), and all-cause mortality.
  
  
  RESULTS
  The factors associated with albuminuria (proteinuria) regardless of eGFR were hematuria, diabetic retinopathy, low hemoglobin, and glomerular lesions. The factors associated with low eGFR regardless of albuminuria (proteinuria) were age and diffuse, nodular, tubulointerstitial, and vascular lesions. The glomerular, tubulointerstitial, and vascular lesions in patients with normoalbuminuria (normal proteinuria) and low eGFR were more advanced compared to those in patients with normoalbuminuria (normal proteinuria) and maintained eGFR. In addition, compared to patients with micro-/macroalbuminuria (mild/severe proteinuria) and low eGFR, their tubulointerstitial and vascular lesions were similar or more advanced in contrast to glomerular lesions. The mean follow-up period was 8.1 years. There were 118 renal events, 62 cardiovascular events, and 45 deaths. The pathological determinants were glomerular lesions, interstitial fibrosis and tubular atrophy (IFTA), and arteriosclerosis for renal events, arteriosclerosis for cardiovascular events, and IFTA for all-cause mortality. The major clinical determinant for renal events and all-cause mortality was macroalbuminuria (severe proteinuria).
  
  
  CONCLUSIONS
  Our study suggests that the characteristic pathological lesions as well as macroalbuminuria (severe proteinuria) were closely related to the long-term outcomes of biopsy-proven diabetic nephropathy in type 2 diabetes.
authors.affiliation: Corresponding author: Takashi Wada, twada@m-kanazawa.jp.
authors.forename: Miho
authors.initials: M
authors.lastname: Shimizu
authors.forename: Kengo
authors.initials: K
authors.lastname: Furuichi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Toyama
authors.forename: Shinji
authors.initials: S
authors.lastname: Kitajima
authors.forename: Akinori
authors.initials: A
authors.lastname: Hara
authors.forename: Kiyoki
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Iwata
authors.forename: Norihiko
authors.initials: N
authors.lastname: Sakai
authors.forename: Toshinari
authors.initials: T
authors.lastname: Takamura
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology; D044466:Asian People; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000473:pathology*; D003930:Diabetic Retinopathy / Q000209:etiology; D005260:Female; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis